PB2320: FIRST LINE THERAPY FOR DIFFUSE LARGE B CELL LYMPHOMA AMONG THE ELDERLY: A TUNISIAN MULTICENTER EXPERIENCE.
Authors: Kmira Zahra, Imtinène Belaid, Karima Kacem, Moez Elloumi, Amel Mezlini, Fehmi Msaddek, Ben Othman Tarek, Toumi Nabil, Raihane Ben Lakhal, Abderrahim Khelif, Ben Ahmed Slim, Khanfir Afef, Adnene Laatiri
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma (DLBCL) is predominantly a disease of the elderly, with incidence increasing with age. Management of elderly or frail patients with DLBCL is a major clinical challenge. The majority of these patients are unfit for aggressive treatment protocols and the lack of randomized trials in this category makes it difficult to choose the best regimen. Aims: We conducted this study with the aim of determining the characteristics of elderly patients with DLBCL and reporting the therapeutic results in this category. Methods: It is a multicenter retrospective study including 228 patients over 60 years old with newly diagnosed DLBCL, treated between January 2013 and December 2020. The diagnosis was confirmed according to the WHO Classification of Hematological malignancies (2008). Disease stage was determined according to Ann Arbor staging system. Patients were treated according to the national protocol non-Hodgkin’s lymphoma 2013 (NHL 2013): patients aged between 60 and 75 years were treated with 6-8 courses of CHOP21+/-Rituximab ®(6 courses for NHL 2013-1: aa-IPI=0 and 8 courses for NHL 2013-3: aa-IPI=1-3)and patients aged over 75 years were treated with 6 courses of miniCHOP21+/-R(NHL 2013-4). The response was evaluated with the International Working Group (IWG) Response Criteria for NHL. The overall survival (OS) and event-free survival (EFS) were estimated with Kaplan Meier. Results: One hundred and sixty six were aged between 61 and 75 years and 62 patients were over 75 years. The median age was 70, 5 years (61-90) with a male predominance (sex ratio 1.3). At diagnosis, the double localization (nodal and extra nodal) was observed in 112 patients (49%). B symptoms were present in 38% of cases. An altered performance status (≥2) was noted in 31,6% of the cases. A raised LDH level was observed in 121patients (53%). The advanced stage (III and IV) was observed in 58%. Bulky mass was noted in 21% of cases. Age adjusted international prognostic index (aaIPI) was high (≥2) in 109 cases (47,8%). Fourty six patients received 6CHOP+/- R regimen (NHL2013-1), 120 Patients received 8 CHOP+/- R regimen (NHL 2013-3) and 62 patients received miniCHOP+/-R regimen (NHL 2013-4). Rituximab was not received in 40 patients (17,6%).The intercourse period was not respected in 35% of cases due to hematological toxicity. Sixteen patients died before the interim evaluation (7,5%)due to tumor progression in 5 patients and toxic death in 11 patients (4,8%). The interim evaluation performed in 211 patients, showed a global response (CR+R>75%), a partial response (50-75%), afailure and a progression in 69%, 22%, 2,5% and6,5% of cases, respectively. Among the 212 patients, ten patients didn’t achieve treatment due to toxic death in 2 cases and tumor progression in 8 cases. In total, the treatment related mortality in our study was 5,7%. Among the 202 patients evaluable at the end of the treatment, the global response, the partial Response, the failure and the progression were observed in 83, 5%, 1%, 5% and 10,5% of cases, respectively.Among the 169 responders, 35 patients (20,7%) have relapsed. The 5-year OSfor patients treated according NHL 2013-1, NHL 2013-3 and NHL 2013-4 was 90%, 59, 3% and 49% (p=0.001), respectively.The 5-year RFS for patients treated according NHL 2013-1, NHL 2013-3 and NHL 2013-4 was 92%, 63% and 58% (p<0.013), respectively. The 5-year EFS for patients treated according NHL 2013-1, NHL 2013-3 and NHL 2013-4 was 80%, 48% and 30% (p<0.015), respectively. Summary/Conclusion: Our results were comparable to the literature. Novel agents alone or in combinations will play an increasingly important role in the management of DLBCL in the elderly, especially in those unable to tolerate R-CHOP or R-miniCHOP. Keywords: Chemotherapy, B cell lymphoma